Follow up:
The patient was followed-up every 4–6 months for around 10 years. During this period, her overall periodontal condition was stable, and routine maintenance was performed. Although few incidents of disease exacerbation with PDs of approximately 4–5 mm around the molars occurred, local nonsurgical measures were sufficient for their management (Figure 3). During that period, the patient developed type 2 diabetes mellitus and hypertension. Towards the end of the nineth year after surgery the patient was diagnosed with breast cancer for which she underwent resective surgery and received hormonal treatment and bisphosphonate injections. The patient could not adhere to the periodontal maintenance program during this period and missed multiple appointments. Consequently, her oral hygiene reduced, and the periodontal status began to deteriorate. PD around tooth #16 increased and arresting disease progression was difficult. Around four years later, the patient finished her breast cancer treatment and resumed her dental visits; PD around tooth #16 had significantly increased up to 9 mm, and surgical intervention was necessary. Cone-beam radiographic evaluation revealed bone loss around the tooth, and extraction and implant placement were planned (Figure 4). However, the tooth was in function and had successfully preserved the space for approximately 14 years.